JIA Flashcards

1
Q

What is JIA

A

Systemic autoimmune inflammatory disorder affecting u16
Can’t tell what arthritis it will turn into
Genetics
Auto-immune
Environment

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2
Q

What is the criteria for JIA?

A

Age <16
Duration >6 weeks
Presence of arthritis

Joint swelling 
Morning stiffness 
Pain / refusal to walk 
Decreased ROM 
Tenderness / warmth 

System - Rash / fever / fatigue / weight loss

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3
Q

What are the different types of JIA

A
Pauciarticular <5 joints (55%)
-Peristent 
-Extended - >6 months 
Polyarticular >5 joints (25%)
Systemic Onset / Stills
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4
Q

How do you Dx

A
No diagnostic test
Dx of exclusion
ESR elevated
ASO titre elevated no strep 
ANA +ve - pauci
RF +ve - poly
MSK exam
X-ray / USS / MRI
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5
Q

Complications of JIA

A

EYE DISEASE

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6
Q

Who is affected by pauciarticular Type 1 and what do they present with

A
Nursery girl
<5
Early + gradual onset 
Limp 
LL 
No systemic Sx
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7
Q

What immunological marker is there in type 1 pauci

A

+ve ANA

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8
Q

Complications of type 1 so what is required

A

Chronic uveitis
Irregular iris
Routine eye checks

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9
Q

Who typically gets type 2 / late onset enthisitis and what does it present with

A
School boy
>8 years 
Limp 
LL joints 
Systemic rare 
ANA-ve 
Iridocyclitis NOT chronic
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10
Q

What is type 2 pauci likely to develop into ?

A
Hip often affected
Spinal pain / sacroiliac tendernes
FH of AS 
May evolve AS / seronegative 
If HLA-B27 +ve + back = Juvenile AS
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11
Q

Who typically gets Type 3 pauci

A

Any age

F>M

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12
Q

What is type 3 pauci often known as

A

Juvenile Psoriatic

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13
Q

What are the symptoms of type 3 pauci

A
Destructive 
Asymemetric UL + LL
Dactylitis 
Chronic idiocyclitis 
FH psoriasis in 40% 
Pitting, onchylsis 
HLA-B27
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14
Q

What types of polyarticular arthritis is there

A

RF -ve and RF +ve

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15
Q

Who normally presents with RF-ve polyarticular

A

Early childhood
F>M
Affects fast growing joints

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16
Q

What are the symptoms of RF-ve polyarticular

A
Symmetric arthritis 
Fever 
Malaise 
HSM 
Anaemia 
Growth problems 
If affects TMJ = limited bite and micrognathia
17
Q

What are the symptoms of Rf

+ve polyarthritis

A
Similar to adult RA 
Nodules 
Fever
MAlaise 
Anameia 
Erosions on X-ray 
Sjogren, Felty, Vasculitis
18
Q

Who normally presents with RF +ve polyarthritis

A

Late childhood

F>M

19
Q

Is iridocyclitis common in polyarticular ?

A

NO it is rare

20
Q

Who gets systemic onset JIA / Still’s disease

A

Any age
Present as very sick child
Extra-articular features define
Most serious JIA

21
Q

What do you typically present with in systemic JIA

A

Fever for 2 weeks with normal blood culture
Salmon eruption rash accompanies fever
+ve Koebner

22
Q

What occurs after initial presentation of fever and rash in JIA

A

Joint arthritis 3-12 months after ever

Only then is diagnosis made

23
Q

What are other symptoms of systemic onset JIA

A
Lymphadenopathy
Weight loss 
HSM 
Abdominal pain
IBD
\+ve transanimase
Uveititis 
Elevated ferritin 
Raised CRP/ ESR
Raised platelets 
Rare 
Pericarditis 
Pleural effusion 
Pulmonary disease
Cardiac tamponade
24
Q

Immunological markers in systemic onset JIA

A

RF -ve

ANA -ve

25
How do you treat Still's
NSAID for fever / pain Steroid if severe Methotrexate -DMARD Anti-TNF
26
What is 1st line in JIA
NSAID | Joint steroid injetions
27
What is 2nd line in JIA
DMARD Biologics - anti-TNF Systemic steroids for serious complications but high SE Local steroids for eye disease
28
Who is rare to require 2nd Line RX
Pauciarticular
29
What are other options
``` Encourage activity Physio OT Surgery Regular ophthalmology review ```
30
What are the signs of uveitis
Red eyes, headache, decreased vision
31
How do you treat uveitis
Topical steroid Systemic stqeroid DMARD + biologic if refractory
32
What are your differentials for JIA
``` SA Reactive arthritis Rheumatic fever SLE Mechanical joint pain Growing pain Malignancy - leukaemia / neuroblastoma / bone Perthe/ SUFE / DDH / fracture ```
33
What is associated with poor prognosis
``` Active disease at 6 months Polyarticular Extended oligoarticular Female Rh factor +ve Ana +ve Persistent raised inflammatory markers ```
34
What are complications
``` Growth issues Psychological School Ocular COntractures ```
35
What type of onset can you get with systemic JIA and what are main features
Adult onset - Swinging fever - worse late afternoon - Salmon pink rash - Polyarthritis